Objective To study the feasibility and efficacy of intraoperative choledoscopy combined with laparoscopic left liver resection to treat intrahepatic lithiasis.Method In 49 patients with biliary stone,laparoscopic left lateral sectionectomy/left medial sectionectomy/left hepatectomy combined with intraoperative choledochoscopy and stone retrieval were carried out.Results Laparoscopic left lateral sectionectomy was carried out in 29 patients,left medial sectionectomy in 2 patients and left hepatectomy in 18 patients.In all the patients,combined choledoscopy and stone retrieval were carried out.A concomitant laparoscopic cholecystectomy (LC) was carried out in 11 patients.The average operative time was 226 min.When LC was carried out,the mean operative time was 243 min.The mean intraoperative blood loss was 378 ml.There was no bile leak or postoperative bleeding.Flatus was passed 1-3 days after surgery.The patients were discharged home 7-10 days after surgery.Postoperative MRI/MRCP did not reveal any residual stone.On a mean follow up of 16 months for 47 patients,the patients did well and there was no recurrent stone.Conclusion Choledochoscopy combined with laparoscopic left liver resection for bile duct stone resulted in minimal trauma to the patient.The recovery was quick and there was a high stone clearance rate.The treatment was safe,efficacious,and it is a viable minimally invasive treatment option.

Objective To analyze the clinicopathological features and prognosis of patients with occult breast cancer ( OBC) , as well as to explore the best treatment .Methods The clinical data of 72 patients with OBC confirmed by pathology were retrospectively analyzed , while 320 cases with other kind of breast cancer were the control group .Results Axillary mass was the first sign of the 72 patients with OBC.The diagnosis rate of MRI was higher than mammary graphy ( 71.4% vs 53.5%) .The difference had statistical significance (χ2 =11.876, P=0.001) .The characteristics of OBC with axillary lymph node metastasis was mainly moderately or low differenti -ated, usually with diffuse infiltrative cancer cells , flaky, like large Apocrine cells.Compared with the control group, the positive rate of CK7, CK20 and TTF-1 had no statistical differences (χ2 =0.058, P=0.810).The posi-tive rate of ER and PR was 46.7% and 36.7%, lower than the control group (χ2 =4.535, P=0.033).Clinical stage, operating method and the number of lymph node metastasis may be the independent factors influencing prog -nosis.Conclusions Axillary mass is the first symptom of OBC .To combine MRI with immunohistochemistry is helpful in diagnosis and differential diagnosis of the disease .The positive rate of ER and PR for OBC patients is low.Modified radical mastectomy combined with adjuvant therapy may be the better choice .

Objective To screen mutations in genes including ASXL1, TET2, IDH1, IDH2, SETBP1, MPL515, JAK2 exon 12 and JAK2V617 in 135 polycythemia vera (PV) patients. To assess progreasson and genomics characteristics post polycythemic myelofibrosis. Methods DNA sequencing of ASXL1(Exon12),TET2 (Exons 3-11),IDH1(Exon4),IDH2(Ex-on4),SEPBP1(Exon4),JAK2 exon 12 and MPL515 (Exon 10) genes were carried out using Sanger method. JAK2V617 muta-tion was detected by allele-specific PCR in patients with PV. In the mean time, the mutation load of JAK2V617F allele (V617F%) was evaluated by real-time PCR using Tagman MGB probe. Then, the significant of gene mutations and clinical outcomes of post-PV Myelofibrosis(PPMF)was analyzed. To study risk factors of PPMF, logistic regression were employed. Results ASXL1, TET2, IDH1, IDH2 were mutated in 7.69%(8/104), 5.26%(1/19) , 0.08%(1/120) and 0.08%(1/121) of all PV patient respectively. JAK2 was mutated in 82.22%(111/135) of PV patients with mutation rate of exon12 of 2.96%(4/135) and there were no mutation of MPL515 and SETBP1 in PV patients. ASXL1 mutation was found in 31.82%(7/22) PPMF patients. Spearman analysis showed that ASXL1 is correlated with JAK2V617F (V617F%) (rs=0.298,P=0.002). The hemo-globin was lower in patients with ASXL1 mutation than patient without mutation (wild type). Leukocyte count, V617F%>50%rate, thrombosis and PPMF were higher in patients with ASXL1 mutation than that of ASXL1 wild type(P＜0.05). ASXL1 mu-tation, V617F%>50% rate and splenomegaly were all risk factors of PPMF. Conclusion ASXL1 mutation is the risk-fac-tor of PPMF and may promote V617F%by some mechanism.

Objective To compare the effect between Mammotome minimally invasive surgery and traditional surgery in resection of youth giant breast fibroadenoma (YGBF).Methods We randomly selected 73 patients who had YGBF and already accepted surgical treatment in our hospital from Jul.2009 to Jan.2016.The 75 patients recruited from screening programmes were alloted to either treatment according to their choice (37 cases in MS and 38 cases in traditional surgery).The median follow-up was 18 months (from 6 to 36 months).Comparative analysis was done between the two groups in operation time,incision healing time,incision length,intraoperative bleeding,wound infection,subcutaneous hematoma,residual tumor,breast deformation,scar size,and patient satisfaction degree.Results There was no statisticaly significant difference betwen these two groups in operation time,intraoperative blood loss,incision infection,subcutaneous hematoma,or residual tumor (P＞0.05),however,MS group was superior to traditional surgery group in the incision healing time,incision length,breast deformation,scar size and postoperative satisfaction degree,and the difference was statistically significant(P＜ 0.05).Conclusion The advantage of Mammotome minimally invasive operation auxiliary for YGBF is obvious,such as fast wound healing,small incision,infection rate,small breast without deformation and scar etc.,also higher satisfaction degree to the treatment,which is regarded as the preferred surgical treatment for YGBF patients.

This study aims to review the biomarkers of depression discovered by proteomic techniques to guide the identification of specific biomarkers for depression. Depression is a common psychological disease， and its diagnosis and efficacy evaluation rely on subjective clinical evaluation， lacking objective diagnostic tools. Proteomics is the primary method to discover and verify biomarkers. This study reviews proteomic biomarkers in brain tissue， cerebrospinal fluid and blood of patients with depression， as well as the latest strategies for screening biomarkers of depression.

ObjectiveTo investigate the mediating role of loneliness and social anxiety in the relationship between basic psychological needs satisfaction and smartphone addiction among high school students， and to provide references for the intervention to smartphone addiction for high school students. MethodsIn April 2022， a total of 14 666 high school students from 5 middle schools in a county of Sichuan Province were included by random sampling method. Basic Psychological Needs Scales （BPNS）， the UCLA Loneliness Scale-3 edition （UCLA-3）， Interaction Anxiousness Scale （IAS） and the Mobile Phone Addiction Index （MPAI） were used for cross-sectional investigation. Bootstrap method was used to analyze the mediating role of loneliness and social anxiety in the relationship between the basic psychological needs satisfaction and smartphone addiction. Results① In this study， 14 036 valid questionnaires were returned， and 1 752 （12.48%， 95% CI： 0.114~0.136） high school students were found to be addicted to smartphone phone. The BPNS score was negatively correlated with UCLA-3， IAS and MPAI scores （r=-0.771， -0.486， -0.417， P<0.01）. And MPAI score was positively correlated with IAS and UCLA-3 scores （r=0.403， 0.424， P<0.01）. IAS score was positively correlated with UCLA-3 score （r=0.458， P<0.01）. ②The degree of basic psychological needs satisfaction in high school students can directly negatively predict smartphone addiction （β=-0.383， P<0.05）， and can also indirectly affect smartphone addiction through loneliness and social anxiety （β=-0.130， P<0.05）. ③Loneliness （indirect effect value was -0.145） and social anxiety （indirect effect value was -0.074） partially mediate between the basic psychological needs satisfaction and smartphone addiction. Loneliness-social anxiety also has significant chain mediating effect （indirect effect value was -0.034）， which accounted for 8.88%. ConclusionThe basic psychological needs satisfaction can not only directly affect the occurrence of smartphone addiction， but also indirectly affect the occurrence of smartphone addiction through the chain mediation of loneliness and social anxiety.